AB0587 THE RISK OF PATIENTS WITH POLYMYALGIA RHEUMATICA AND GIANT CELL ARTERITIS TO DEVELOP DIABETES AND OSTEOPOROSIS ON FOLLOW UP
Authors: M. Bahl, M. Stöcker, S. Tsiami, X. Baraliakos, J. Braun, U. Kiltz
Journal: Annals of the Rheumatic Diseases (2022)

Background Patients with polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are commonly treated with glucocorticoids (GC) in different dosages. Therefore, the most common comorbidities that may develop are osteoporosis (OPO) and diabetes mellitus (DM). Objectives To study the development of these comorbidities in the management of PMR and GCA in a real-life setting. Methods In a retrospective study design, longitudinal data of patients with a clinical diagnosis of PMR and GCA treated in a tertiary center were studied. Patients and disease characteristics were documented according to clinical routine in patients in whom ≥ 2 documented visits ≥ 3 months apart had been documented. Results A total of 550 patients (382 PMR, 168 GCA) was analysed (Table 1). The time period of follow up (FU) ranged between 3 months and 13.6 years (mean 1.4 (0.3) years). The majority of patients received a diagnosis of PMR or GCA in our center while 29.5% of patients came for a second opinion. Their mean age was around 70 years, and most patients were female (Table 1). Eight GCA patients were already blind (4.8%) at first presentation, and 77 and 80 patients had a diagnosis of DM (15.5%) and OPO (16.0), respectively, already at baseline. During FU 56 PMR (16.0%) and 7 GCA patients (4.2%) were diagnosed with another autoimmune disease, mainly with rheumatoid arthritis (n=50 (69.4%)). The mean dose of GC differed substantially between groups (Table 1). On FU, 9 (2.4%) and 5 (3.0%) of PMR and GCA patients developed DM and 17 (4.5%) and 14 (8.4%) OPO, respectively. Thus, about 20% and 25% of patients with PMR or GCA finally had DM and OPO, respectively. Almost all patients received vitamin D and antiresorptive agents. Table 1. Patients and disease characteristics PMR patients (n=382) GCA patients (n=168) Significance Age (years) 68,2 (9.3) 71.1 (8,6) 0.9 BMI (kg/m 2 ) 27.0 (4.9) 26.0 (5,3) 0.44 Female sex, n (%) 216 (56.6) 121 (72,0) &lt;0.001 Time to rheumatologist (months) 2.1 (9,7) 1.4 (5,4) 0,33 CRP at baseline (mg/dl) 3,8 (4,6) 4,5 (5,5) 0,07 Prednisolone at baseline (mg/d) 25.1 (20,2) 52.0 (69,7) &lt;0.001 Comorbidities at baseline -Number of comorbidities (mean) 1.45 (1.12) 1.51 (1.12) 0.26 -Diabetes, n (%) 61 (16.0) 24 (14.3) 0.36 -Osteoporosis, n (%) 64 (16.8) 30 (17.9) 0.7 -Ischemic heart disease, n (%) 38 (9.9) 19 (11.4) 0.46 Organ manifestation and comorbidities at FU -Blindness n (%) 6 (1.6) 8 (4.8) 0.048 -Aneurysm n (%) 1 (0.3) 9 (5.4) &lt;0.001 -Diabetes, n (%) 70 (18.4) 29 (17.3) 0.89 -Osteoporosis, n (%) 81 (21.4) 44 (26.3) 0.003 -Vascular stenosis 4,6 10,1 0,048 values given as mean (SD) Conclusion In this large real-life cohort, patients with PMR and GCA aged around 70 years were seen by rheumatologists about 1-2 months after their first symptom but 8 GCA patients were already blind at first visit. DM and OPO were frequent comorbidities in both, PMR and GCA patients, already at baseline and during follow-up more patients developed these comorbidities despite prophylactic and therapeutic medication. OPO and DM should be a routine concern in the care of PMR and GCA patients - already when glucocorticoids are started. Disclosure of Interests None declared